Information Collection

Request for Reinstatement (Title XVI)

IC 45441 under ICR 202203-0960-004 · OMB 0960-0744.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-372 Request for Reinstatement (Title XVI)	Form
Form SSA-372 Request for Reinstatement -- Title XVI Request for Reinstatement (Title XVI)	Form
SSA-372 Request for Reinstatement -- Title XVI SSA-372 (revised).pdf	Form
SSA-372 Request for Reinstatement -- Title XVI SSA-372 (revised).pdf	Form
SSA-372 (current).pdf Current SSA-372	IC Document
SSA-372 (current).pdf Current SSA-372	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.999 - 416.999d

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-372				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	0	2,000
Annual IC Time Burden (Hours)	1,767	1,700	67
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-372		05/24/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].